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General NPI Number Information
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NPI Number | 1366256554
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Entity Type | Organization
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Legal Business Name | SOUTH PADRE ISLAND PEDIATRIC CENTER
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 415 E 4TH ST
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City | ALICE
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State | TX
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Zip | 78332-4727
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Country | US
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Telephone | 361-664-8945
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Fax |
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Provider Business Mailing Address
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Address Line | 3845 S PADRE ISLAND DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78415-2919
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Country | US
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Telephone | 361-854-4626
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | LINDSEY ZIERHUT
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Credential |
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Telephone | 985-646-1580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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